Laparoscopy Combined With Endoscopic Therapy In The Clinical Treatment Of Cholecystolithiasis And Extrahepatic Bile Duct Cholelithiasis

Objective(s):In this study,retrospective comparative analyses were conducted for the investigation of different minimally invasive therapies for the treatment of cholecystolithiasis and extrahepatic bile duct cholelithiasis.Multiple indicators,including the incidence of postoperative acute pancreatitis,residual stone after operation,postoperative gastrointestinal function recovery time,postoperative hospital stay,and recurrence rate concluded from the 1-year follow-up,were considered in the analyses for the clinical treatment effects of different minimally invasive therapies including:combination therapy of laparoscopic cholecystectomy(LC),laparoscopic common bile duct exploration(LD),choledochoscopic calculus-removing,endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic nasobiliary drainage(ENBD),the combination therapy of LC,ERCP,edoscopic sphincterotomy(EST),ENBD,and the combination therapy of LC,LD,choledochoscopic calculus-removing and T-tubedrainage(TD).Both advantages and disadvantages of those combination therapies in the treatment of cholecystolithiasis and extrahepatic bile duct cholelithiasis were discussed in this study,providing evidences and basis for the optimal therapy in the clinical treatment of this disease.Methods:Retrospective comparative analyses of the data collected during December of 2017 to December of 2019 from Second Affiliated Hospital of Kunming Medical University Hepatobiliary pancreatic surgery.A total of 98 cholecystolithiasis and extrahepatic bile duct cholelithiasis cases were divided into 3 groups according to the combination therapy:Group A,27 cases,LC+LD+ERCP+ENBD;Group B,30 cases,LC+ERCP+EST+ENBD;and Group C,41 cases,LC+LD+TD.General clinical background of all the patients including:gender,age,alanine aminotransferase(ALT)level,aspartate aminotransferase(AST)level,direct bilirubin(DBIL),total bilirubin(TBIL),common bile duct diameter,maximum diameter of bile duct calculus and calculus of bile duct count,were collected before therapy.These data were subjected to statistical analysis to investigate the comparability between groups.Comparative analyses of postoperative biliary leakage,acute pancreatitis,acute cholangitis,residual stones,gastrointestinal function recovery time and hospital stay were conducted between the data collect before and after the therapy.Meanwhile,regular follow-up trough phone of the patients was conducted at 1 month,3 months,6 months and 1 year after the therapies.Data such as abdominal colour Doppler ultrasound,CT,magnetic resonance(MRCP)and ERCP(1 months after therapy for patients with indwelling T-Tube)were collected for the analyses of the recurrence rates.Further statistical analysis was conducted for the differences of recurrence rates between those combination therapies.Results:1.General clinical information:there was no statistical difference in the gender,age ALT level,AST level,DBIL,TBIL,common bile duct diameter,maximum diameter of bile duct calculus and calculus of bile duct count between the 3 groups(p>0.05),suggesting comparability between groups.2.Status after therapies:The postoperative hospital stay in group A and B is shorter than that in group C,with significant difference(P<0.05).Compared with group B,hospital stay in group A is shorter than that in group B,and the difference of staying time is not statistically significant(P>0.05).The postoperative recovery time of gastrointestinal function in group A and B is shorter than that in group C(P<0.05).Compared with group B,the postoperative recovery time of gastrointestinal function in group A is shorter than that in group B,with no significant difference(P>0.05).3.Postoperative complications:there was no significant difference between the 3 groups in the postoperative biliary leakage,acute pancreatitis,acute cholangitis,residual stones and total incidences of complications(p>0.05).4.Recurrence rates in the follow-up:there was no significant difference between the 3 groups in the recurrence rates after 1-year follow-up.Conclusion(s):1.All of the 3 combination therapies including:LC+LD+TD,LC+ERCP+EST+ENBD and LC+LD+ERCP+ENBD are effective in the clinical treatment of cholecystolithiasis and extrahepatic bile duct cholelithiasis.2.Combination therapy of LC,LD and TD displayed lower postoperative acute pancreatitis,however with longer postoperative gastrointestinal function recovery time.3.Combination therapy of LC,LD,ERCP and ENBD kept the integrity of ductus choledochus,therefore was effective in attenuating the incidence of postoperative biliary leakage,and displayed shorter postoperative gastrointestinal function recovery time,however with higher incidence of postoperative acute pancreatitis.4.By adopting LC+LD+ERCP+ENBD,the duodenal papilla sphincter function can be retained,the choledoch is sutured in the first phase and effective postoperative drainage is arranged.Therefore,the occurrence of postoperative acute pancreatitis is reduced,the gastrointestinal function can be recovered shortly,and consequently the patients can pull through in a shorter term and their hospital stay can be shortened.So the clinical implication of adopting LC+LD+ERCP+ENBD in the treatment of gallstone complicated with calculus of extrahepatic bile duct should be prioritized in minimally invasive operations and is worthy to be promoted and applied.